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El Miedany Y, El Gaafary M, Toth M, Palmer D, Ali A, Bahlas S, Mahran S, Hassan W, Abu-Zaid MH, Saber S, Elwakil W. Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure. Semin Arthritis Rheum 2023; 63:152285. [PMID: 37944298 DOI: 10.1016/j.semarthrit.2023.152285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Giant Cell Arteritis (GCA) is the commonest form of systemic vasculitis in people over the age of 50. Published research highlighted the lack of a disease-specific patient reported outcomes (PROMs) for GCA. OBJECTIVES To assess the validity, reliability and responsiveness to change of a devised disease specific patient self-reported outcome measures questionnaire for Giant Cell Arteritis (GCA). METHODS The GCA-PROMs was conceptualized based on frameworks outlined in the OMERACT developed core set of Outcome Measures for Large-Vessel Vasculitis and the guiding principles of the FDA guidance. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. RESULTS A total of 54 GCA patients completed the questionnaire. The GCA-PROMs questionnaire was reliable as demonstrated by a high standardized alpha (0.878-0.983). Content construct assessment of the GCA-PROMs functional disability and QoL revealed significant correlation (p< 0.01) with both HAQ and EQ-5D. Changes in functional disability, QoL showed significant (p< 0.01) variation with diseases activity status in response to therapy. CONCLUSIONS The developed GCA-PROMs questionnaire is a reliable and valid instrument for assessment of GCA patients. A stratified treatment regimen depending on the individual patient's risk factors as well as preferences and associated comorbidities is the best approach to tailored patient management.
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Voetterl H, van Wingen G, Michelini G, Griffiths KR, Gordon E, DeBeus R, Korgaonkar MS, Loo SK, Palmer D, Breteler R, Denys D, Arnold LE, du Jour P, van Ruth R, Jansen J, van Dijk H, Arns M. Brainmarker-I Differentially Predicts Remission to Various Attention-Deficit/Hyperactivity Disorder Treatments: A Discovery, Transfer, and Blinded Validation Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:52-60. [PMID: 35240343 DOI: 10.1016/j.bpsc.2022.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder is characterized by neurobiological heterogeneity, possibly explaining why not all patients benefit from a given treatment. As a means to select the right treatment (stratification), biomarkers may aid in personalizing treatment prescription, thereby increasing remission rates. METHODS The biomarker in this study was developed in a heterogeneous clinical sample (N = 4249) and first applied to two large transfer datasets, a priori stratifying young males (<18 years) with a higher individual alpha peak frequency (iAPF) to methylphenidate (N = 336) and those with a lower iAPF to multimodal neurofeedback complemented with sleep coaching (N = 136). Blinded, out-of-sample validations were conducted in two independent samples. In addition, the association between iAPF and response to guanfacine and atomoxetine was explored. RESULTS Retrospective stratification in the transfer datasets resulted in a predicted gain in normalized remission of 17% to 30%. Blinded out-of-sample validations for methylphenidate (n = 41) and multimodal neurofeedback (n = 71) corroborated these findings, yielding a predicted gain in stratified normalized remission of 36% and 29%, respectively. CONCLUSIONS This study introduces a clinically interpretable and actionable biomarker based on the iAPF assessed during resting-state electroencephalography. Our findings suggest that acknowledging neurobiological heterogeneity can inform stratification of patients to their individual best treatment and enhance remission rates.
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Lamarca A, Palmer D, Wasan H, Ross P, Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maravellas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. 54MO Quality of life (QoL) and value of health (V-He) in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+FOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lamarca A, Palmer D, Wasan H, Ross P, Ting Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maraveyas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. P-88 Clinical role of tumour markers in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+mFOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lamarca A, Roberts K, Graham J, Kocher H, Chang D, Ghaneh P, Jamieson N, Propper D, Bridgewater J, Ajithkumar T, Palmer D, Wedgwood K, Grose D, Corrie P, Valle J. P-85 Pre-surgical staging and surveillance after curative treatment for pancreatic ductal adenocarcinoma (PDAC): Survey of practice in the United Kingdom (UK). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wacker BK, Bi L, Sorci-Thomas M, Ng P, Palmer D, Tang C, Dichek D. Abstract 430: GFP-tagging Of Rabbit ApoAI Decreases Expression And Cholesterol-efflux Activity. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction:
Gene therapy using a helper-dependent adenovirus (HDAd) to express rabbit apolipoprotein (apo) AI in carotids of fat-fed rabbits reduces atherosclerosis. We hypothesize that transgenic apoAI promotes reverse cholesterol transport from the artery wall; however, this could not be tested because the transgenic rabbit apoAI is indistinguishable from endogenous rabbit apoAI. We therefore constructed an HDAd expressing GFP-tagged rabbit apoAI.
Methods:
We constructed HDAdGFPapoAI by fusing the GFP sequence to the N-terminus of the rabbit
APOA1
gene with a short linker. Bovine aortic endothelial cells (BAEC) were transduced with HDAdGFPapoAI, washed, and incubated in serum-free medium for 24h. Conditioned medium (CM) was collected and fluorescence measured. Cell extracts and CM were analyzed by western blotting for protein size, expression level, and presence of GFP and apoAI antigens. CM cholesterol-efflux activity was measured using cholesterol-loaded BHK cells expressing ABCA1.
Results:
CM of HDAdGFPapoAI-transduced BAEC had green fluorescence and contained a protein of the size predicted for the GFP-apoAI fusion (~56 kDa), which was detected with antibodies to both GFP and apoAI. A smaller protein (~30 kDa) with GFP and apoAI antigens was also detected. Compared to a vector expressing WT rabbit apoAI, GFP-tagging decreased expression of apoAI protein by ~50% and the percentage of secreted apoAI from 55% to 13%. In combination, this reduced secreted GFP-apoAI to only 12% of levels of secreted WT apoAI. While CM containing WT rabbit apoAI strongly stimulated cholesterol efflux from BHK cells (46%), GFP-apoAI-containing CM did not promote cholesterol efflux compared to CM from untransduced BAEC (7.8% vs 7.4% efflux), even when present in CM at a concentration similar to that of WT apoAI.
Conclusion:
GFP-rabbit apoAI protein has reduced expression and secretion (likely due to misfolding/degradation) and does not promote cholesterol efflux (n-terminal GFP may disrupt the phospholipid/cholesterol organization needed for efflux via ABCA1 to this dynamic apoprotein). It will not be useful to investigate mechanisms of atheroprotection by vessel wall-expressed apoAI. Alternatives include use of a smaller tag or expression of human apoAI.
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Knox J, McNamara M, Goyal L, Cosgrove D, Springfeld C, Sjoquist K, Park J, Verdaguer H, Braconi C, Ross P, Oh DY, De Gramont A, Shroff R, Zalcberg J, Palmer D, Valle J. 59TiP Phase III study of NUC-1031 + cisplatin vs gemcitabine + cisplatin for first-line treatment of patients with advanced biliary tract cancer (NuTide:121). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Laethem JLV, Borbath I, Karwal M, Verslype C, Van Vlierberghe H, Kardosh A, Zagonel V, Stal P, Sarker D, Palmer D, Vogel A, Edeline J, Cattan S, Kudo M, Cheng AL, Ogasawara S, Siegel A, Chisamore M, Wang A, Zhu A. 933P Updated results for pembrolizumab (pembro) monotherapy as first-line therapy for advanced hepatocellular carcinoma (HCC) in the phase II KEYNOTE-224 study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Palmer D, Pou JO, Díaz-Ferrero J, Conesa JA, Ortuño N. Kinetics of the formation and destruction of PCDD/Fs in a laboratory tubular furnace. CHEMOSPHERE 2021; 276:130175. [PMID: 33714154 DOI: 10.1016/j.chemosphere.2021.130175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
A kinetic model has been developed for the formation of selected congeners of PCDD/Fs during the thermal decomposition of different wastes in a horizontal reactor. Previously published data on the decomposition of wastes have been correlated using a kinetic model that only considers process parameters, such as the presence of different amounts of oxygen in the atmosphere of reaction, chlorine and metals in the waste. The effect of both chlorine and metals is modelled through an equation assuming a "saturation effect", i.e., that a certain amount of each substance produces the maximum rate, and that higher amounts do not increase the rate. The presence of oxygen is modelled by a destruction reaction over part of the PCDD/Fs produced. The model, which uses data from more than 64 experiments, correlated the emissions of three selected congeners: 1,2,3,6,7,8-HxCDD, OCDF and 2,3,7,8-TCDF, which are enough to estimate the total amount and toxicity of an emission.
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Edeline J, Lamarca A, McNamara M, Jacobs T, Hubner R, Palmer D, Johnson P, Guiu B, Valle J. P-229 Systematic review and pooled analysis of locoregional therapies in patients with intrahepatic cholangiocarcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Taieb J, Hammel P, Reni M, Palmer D, Bridgewater J, Cubillo A, Prager G, Bayle S, Hédouin-Biville F, Teng Z, Seufferlein T, Macarulla T. SO-3 Treatment sequences and prognostic factors in metastatic pancreatic ductal adenocarcinoma: Univariate and multivariate analyses of a real-world study in Europe. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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El-Miedany Y, El Gaafary M, El Aroussy N, Bahlas S, Palmer D. OP0304-PARE DEVELOPMENT OF INTERACTIVE DECISION AID TOOL FOR MOTHERHOOD AND PARENTHOOD AMONG PATIENTS LIVING WITH AUTOIMMUNE RHEUMATIC DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:There are clear educational pregnancy-related needs for both women and men living with Autoimmune Rheumatic Diseases (ARDs) who seek specific advice from their health care providers. Most of the time those subjects would seek specific information regarding their chances of pregnancy, impact of the disease, as well as safety of their medications during pregnancy and breast feeding. They also require emotional and physical support as well as advice towards practical coping strategies to manage pain and disease flares particularly during the postnatal period.Objectives:To evaluate the effectiveness of a new interactive pregnancy decision aid (DA) developed for both men and women living with inflammatory arthritis.Methods:Driven by the Cochrane review of patient decision aids (DA) and the International Patient Decision Aids framework (IPDAS), which identify shared decision making (SDM) instrument as evidence-based tools designed to help people engage in deliberative management-related decision making by providing information on the options and outcomes relevant to health status. This project involved an overall three-phase SDM aid development. It has been set up for both men and women and included information on pregnancy, contraception and breast feeding. The first phase included the development of the decision tool and review by expert faculty composed of: decision experts, patient representatives, policy makers, and patients living with RA, PsA, AS and SLE. The second phase was a pilot testing of the tool in both online and paper format styles. The third phase involved an evaluation of the decision support tool and its impact on the patients. The DA adopted an interactive style with embedded video recordings (this was converted into text in the paper format). All the patient completed these questionnaires: the ReproKnow, Decisional Conflict Scale (DCS), Hospital Anxiety and Depression Scale (HADS), and Arthritis Self-Efficacy Scale (ASES) pre- and post-intervention. A control group of 92 patients (19 men and 71 women) managed according to the standard protocols was also included. Comprehensibility of the video recordings were also assessed using VAS (0-10).Results:126 patients shared in this work (101 women and 25 men). The patients who received the DA had an 81% (women) and 83% (men) increase in ReproKnow scores and a 76 % decrease in scores on the decisional conflict (DCS), compared to the control group (10 % and 11 % respectively); p< 0.001. There were no changes in the scores of depression and anxiety symptoms (p= 0.873) indicating no adverse psychological impact detected. There was no significant difference in terms of self-efficacy assessment p=0.481. The patients rated the comprehensibility of the video recording as high (9.4/10)Conclusion:The DA which was developed to support pregnancy and breast feeding decision-making for patients with ARDs. The interactive SDM aid was found to be a simple, user-friendly tool which can be implemented in standard clinical practice. The interactive style made it more comprehensible to the patients. It is consistent with the IPDAS criteria. Results revealed its effectiveness in improving relevant knowledge and reducing decisional conflict without causing distress to the patients.Disclosure of Interests:None declared.
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Sangro B, Harding J, Johnson M, Palmer D, Edeline J, Abou-Alfa G, Cheng A, Decaens T, El-Khoueiry A, Finn R, Galle P, Park J, Yau T, Begic D, Shen Y, Neely J, Sama A, Kudo M. Abstract No. 117 A phase 3, double-blind, randomized study of nivolumab and Ipilimumab), nivolumab monotherapy, or placebo plus transarterial chemoembolization in patients with intermediate-stage hepatocellular carcinoma. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lee RJ, Wysocki O, Bhogal T, Shotton R, Tivey A, Angelakas A, Aung T, Banfill K, Baxter M, Boyce H, Brearton G, Copson E, Dickens E, Eastlake L, Gomes F, Hague C, Harrison M, Horsley L, Huddar P, Hudson Z, Khan S, Khan UT, Maynard A, McKenzie H, Palmer D, Robinson T, Rowe M, Thomas A, Tweedy J, Sheehan R, Stockdale A, Weaver J, Williams S, Wilson C, Zhou C, Dive C, Cooksley T, Palmieri C, Freitas A, Armstrong AC. Erratum to 'Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome': [ESMO Open Volume 6, Issue 1, February 2021, 100005]. ESMO Open 2021; 6:100056. [PMID: 33545518 PMCID: PMC7842131 DOI: 10.1016/j.esmoop.2021.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lee RJ, Wysocki O, Bhogal T, Shotton R, Tivey A, Angelakas A, Aung T, Banfill K, Baxter M, Boyce H, Brearton G, Copson E, Dickens E, Eastlake L, Gomes F, Hague C, Harrison M, Horsley L, Huddar P, Hudson Z, Khan S, Khan UT, Maynard A, McKenzie H, Palmer D, Robinson T, Rowe M, Thomas A, Tweedy J, Sheehan R, Stockdale A, Weaver J, Williams S, Wilson C, Zhou C, Dive C, Cooksley T, Palmieri C, Freitas A, Armstrong AC. Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome. ESMO Open 2021; 6:100005. [PMID: 33399072 PMCID: PMC7808077 DOI: 10.1016/j.esmoop.2020.100005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.
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Nam K, Larholt K, Hirsch G, Beninger P, Fritsche D, Shoda D, Ferguson J, Bourgeois FT, Palmer D, Katz K, Courtney MW. Dynamic Dossier in the Cloud: A Sociotechnical Architecture for a Real-Time and Metrics-Based Data Tracking System with Gene and Cell Therapies as a Case Study. Ther Innov Regul Sci 2020; 55:388-400. [PMID: 33118143 PMCID: PMC7864828 DOI: 10.1007/s43441-020-00227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/09/2020] [Indexed: 01/19/2023]
Abstract
Background Data sharing among stakeholders in the development, access, and use of drug therapies is critical but the current system and process are inefficient. Methods We take a Systems Engineering approach with a realistic use case to propose a scalable design for multi-stakeholder data sharing. Results We make three major contributions to the drug development and healthcare communities: first, a methodology for developing a multi-stakeholder data sharing system, with its focus on high-level requirements that influence the design of the system architecture and technology choice; second, the development of a realistic use case for long-term patient and therapy data tracking and sharing in the use of potentially curative and durable gene and cell therapies. Further, a bridge for the ‘awareness gap’ was found between the payer (Payer is organization which takes care of financial and operational aspects (which include insurance plans, provider network) of providing health care to US citizens. Or refer to health care insurers.) and the regulator communities by illustrating the common data tracking needs, which highlights the need for coordinated data activities; and third, a proposed system architecture for scalable, multi-stakeholder data sharing. Next steps are briefly discussed. Conclusion We present a system design for multiple stakeholders such as the payer, the regulator, the developer (drug manufacturer), and the healthcare provider to share data for their decision-making. The stakeholder community would benefit from collaboratively moving the system development proposal forward for efficient and cost-effective data sharing.
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Arrow P, Piggott S, Carter S, McPhee R, Atkinson D, Mackean T, Kularatna S, Tonmukayakul U, Brennan D, Nanda S, Palmer D, Jamieson L. Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial. JDR Clin Trans Res 2020; 6:430-439. [PMID: 33016169 DOI: 10.1177/2380084420963949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The management of early childhood caries (ECC) is challenging. OBJECTIVES A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. METHODS Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. RESULTS A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. CONCLUSION A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. KNOWLEDGE TRANSFER STATEMENT This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.
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Knox J, McNamara M, Goyal L, Doherty M, Cosgrove D, Springfeld C, Sjoquist K, Park J, Verdaguer H, Braconi C, Ross P, De Gramont A, Zalcberg J, Palmer D, Valle J. 80TiP Global phase III study of NUC-1031 plus cisplatin vs gemcitabine plus cisplatin for first-line treatment of patients with advanced biliary tract cancer (NuTide:121). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vollebregt MA, Kenemans JL, Buitelaar JK, Deboer T, Cain SW, Palmer D, Elliott GR, Gordon E, Fallahpour K, Arns M. Annual variation in attentional response after methylphenidate treatment. Eur Child Adolesc Psychiatry 2020; 29:1231-1236. [PMID: 31748987 DOI: 10.1007/s00787-019-01434-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
Prevalence rates of attention-deficit/hyperactivity disorder (ADHD) differ with geographical areas varying in sunlight intensity. Sun- or daylight reaching the retina establishes entrainment of the circadian clock to daylight. Changes herein, hence, alterations in clock alignment, could be reflected indirectly in inattention via sleep duration. We here studied (1) annual variation in inattention at treatment initiation; (2) annual variation in response to ADHD treatment [methylphenidate (MPH)] by day of treatment initiation; and (3) dose dependence. We predicted least baseline inattention during a period of high sunlight intensity implying more room for improvement (i.e., a better treatment response) when sunlight intensity is low. These hypotheses were not confirmed. High-dose treated patients, however, had significantly better attention after treatment than low-dosed treated patients, only when treated in the period from winter to summer solstice. Change in solar irradiance (SI) during low-dosed treatment period was negatively related to attentional improvement. The above described findings were primarily found in inattention ratings and replicated in omission errors on a continuous performance task. Daylight and inattention have been proposed to be related via mediation of the circadian system. One mechanism of MPH may be to enhance sensitivity to the diurnal entrainment to sunlight and the question can be raised whether appropriate lighting could potentiate the effects of stimulants.
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Corrie PG, Qian W, Basu B, Valle JW, Falk S, Lwuji C, Wasan H, Palmer D, Scott-Brown M, Wadsley J, Arif S, Bridgewater J, Propper D, Gillmore R, Gopinathan A, Skells R, Bundi P, Brais R, Dalchau K, Bax L, Chhabra A, Machin A, Dayim A, McAdam K, Cummins S, Wall L, Ellis R, Anthoney A, Evans J, Ma YT, Isherwood C, Neesse A, Tuveson D, Jodrell DI. Scheduling nab-paclitaxel combined with gemcitabine as first-line treatment for metastatic pancreatic adenocarcinoma. Br J Cancer 2020; 122:1760-1768. [PMID: 32350413 PMCID: PMC7283477 DOI: 10.1038/s41416-020-0846-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/19/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nab-paclitaxel plus gemcitabine (nabP+gemcitabine) offers modest survival gains for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Sequential scheduling of nabP+gemcitabine in a PDAC mouse model improved efficacy; this hypothesis was tested in a clinical trial. METHODS Patients with previously untreated metastatic PDAC were randomised to receive nabP+gemcitabine administered either concomitantly on the same day, or sequentially, with gemcitabine administered 24 h after nabP. The primary outcome measure was progression-free survival (PFS). Secondary outcome measures were objective response rate (ORR), overall survival (OS), safety, quality of life (QoL) and predictive biomarkers. RESULTS In total, 71 patients received sequential (SEQ) and 75 concomitant (CON) treatment. Six-month PFS was 46% with SEQ and 32% with CON scheduling. Median PFS (5.6 versus 4.0 months, hazard ratio [HR] 0.67, 95% confidence interval [95% CI] 0.47-0.95, p = 0.022) and ORR (52% versus 31%, p = 0.023) favoured the SEQ arm; median OS was 10.2 versus 8.2 months (HR 0.93, 95% CI 0.65-1.33, p = 0.70). CTCAE Grade ≥3 neutropaenia incidence doubled with SEQ therapy but was not detrimental to QoL. Strongly positive tumour epithelial cytidine deaminase (CDA) expression favoured benefit from SEQ therapy (PFS HR 0.31, 95% CI 0.13-0.70). CONCLUSIONS SEQ delivery of nabP+gemcitabine improved PFS and ORR, with manageable toxicity, but did not significantly improve OS. CLINICAL TRIAL REGISTRATION ISRCTN71070888; ClinialTrials.gov (NCT03529175).
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Greeff JC, Liu S, Palmer D, Martin GB. Temporal changes in circulatory blood cell parameters of sheep genetically different for faecal worm egg count and diarrhoea from late summer to spring in a Mediterranean environment. ANIMAL PRODUCTION SCIENCE 2020. [DOI: 10.1071/an19038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Differences in haematology traits were investigated in worm-resistant and worm-susceptible Merino sheep that were genetically prone or less prone to developing diarrhoea in a winter rainfall region. The experiment was a 2 × 2 × 2 × 5 design. Male and female sheep aged 8–9 months old identified as having high (H) or low (L) breeding values for dags (breech soiling) and for worm egg counts (WEC) were allocated to one of four genetic groups: HH, HL, LH and LL (the first letter refers to dags and the second to WEC). The animals were sampled five times from autumn through winter to spring, in March, May, June (ewes only), July (rams only), August and in September after exposure to a natural paddock infection dominated by Trichostrongylus, Teladorsagia, Chabertia and Oesophagostomum. Measurements were packed cell volume, haemoglobin, red blood cell count, differential white cell counts, WEC and faecal consistency score. At all sampling times, there were large (P < 0.01) differences between groups within sex for both the faecal consistency score and WEC. The genetic effect for WEC was large (P < 0.01), as worm-susceptible sheep shed 10- (ewes) and 6-fold (rams) as many worm eggs at their WEC peak as the worm-resistant sheep at the end of the experiment. In the high-dag groups, the faecal consistency score was ~0.5 units higher for rams and 0.4 units higher for ewes, throughout the experiment. The optimum time to measure dags and WEC in this environment appears to be 6–8 weeks after the start of the winter rain. No differences were found among any of the treatment groups for any haematology trait. The haematogram changed significantly throughout the experiment, but genetic selection for low-dag score (reduced diarrhoea) or low WEC did not provide an acceptable discriminator in circulatory haematology traits between these genetically distinct groups of Merino sheep. It was concluded that circulatory haematology traits do not offer opportunities to select against diarrhoea or increased worm resistance in sheep.
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Palmer D, Møller AS, Greenhalf B, Ma Y, Valle J, Gjertsen T, Kuryk L. Multiple KRAS mutations detected by cancer related DNA in patients with resected pancreas adenocarcinoma during treatment with TG01/GM-CSF and gemcitabine (CT TG01-01). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gerrits B, Vollebregt MA, Olbrich S, van Dijk H, Palmer D, Gordon E, Pascual-Marqui R, Kessels RPC, Arns M. Probing the "Default Network Interference Hypothesis" With EEG: An RDoC Approach Focused on Attention. Clin EEG Neurosci 2019; 50:404-412. [PMID: 31322000 DOI: 10.1177/1550059419864461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Studies have shown that specific networks (default mode network [DMN] and task positive network [TPN]) activate in an anticorrelated manner when sustaining attention. Related EEG studies are scarce and often lack behavioral validation. We performed independent component analysis (ICA) across different frequencies (source-level), using eLORETA-ICA, to extract brain-network activity during resting-state and sustained attention. We applied ICA to the voxel domain, similar to functional magnetic resonance imaging methods of analyses. The obtained components were contrasted and correlated to attentional performance (omission errors) in a large sample of healthy subjects (N = 1397). We identified one component that robustly correlated with inattention and reflected an anticorrelation of delta activity in the anterior cingulate and precuneus, and delta and theta activity in the medial prefrontal cortex and with alpha and gamma activity in medial frontal regions. We then compared this component between optimal and suboptimal attentional performers. For the latter group, we observed a greater change in component loading between resting-state and sustained attention than for the optimal performers. Following the National Institute of Mental Health Research Domain Criteria (RDoC) approach, we prospectively replicated and validated these findings in subjects with attention deficit/hyperactivity disorder. Our results provide further support for the "default mode interference hypothesis."
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Alabraba E, Joshi H, Bird N, Griffin R, Sturgess R, Stern N, Sieberhagen C, Cross T, Camenzuli A, Davis R, Evans J, O'Grady E, Palmer D, Diaz-Nieto R, Fenwick S, Poston G, Malik H. Increased multimodality treatment options has improved survival for Hepatocellular carcinoma but poor survival for biliary tract cancers remains unchanged. Eur J Surg Oncol 2019; 45:1660-1667. [DOI: 10.1016/j.ejso.2019.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
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Griffiths KR, Jurigova BG, Leikauf JE, Palmer D, Clarke SD, Tsang TW, Teber ET, Kohn MR, Williams LM. A Signature of Attention-Elicited Electrocortical Activity Distinguishes Response From Non-Response to the Non-Stimulant Atomoxetine in Children and Adolescents With ADHD. J Atten Disord 2019; 23:744-753. [PMID: 28974127 PMCID: PMC8215986 DOI: 10.1177/1087054717733044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Atomoxetine has several characteristics that make it an attractive alternative to stimulants for treating ADHD, but there are currently no tests identifying individuals for whom the medication should be a first-line option. METHOD Within the ADHD Controlled Trial Investigation Of a Non-stimulant (ACTION) study, we examined neuro-cortical activity in 52 youth with ADHD. Baseline event-related potentials (ERP) were compared between those who subsequently responded to 6 weeks of atomoxetine versus those who did not. RESULTS Responders were distinguished by significantly lower auditory oddball N2 amplitudes than both non-responders and typically developing controls, particularly in the right frontocentral region ( p = .002, Cohen's d = 1.1). Leave-one-out cross validation determined that N2 amplitude in this region was able to accurately predict non-responders with a specificity of 80.8%. There were no P3 differences between responders and non-responders. CONCLUSION The N2 amplitude is a biomarker that may have utility in predicting response to atomoxetine for youth with ADHD.
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